CPT code 11760 is a medical code used to describe the procedure for the repair of a nail bed.
CPT code 11760 is used to describe the medical procedure for the repair of a nail bed. This code is typically utilized when a patient has experienced trauma or injury to the nail bed, which is the skin beneath the nail plate. The procedure involves cleaning, repairing, and sometimes reconstructing the nail bed to promote proper healing and nail growth. This can include suturing lacerations, removing damaged tissue, and ensuring the nail bed is properly aligned. Proper coding of this procedure is essential for accurate billing and reimbursement in the healthcare revenue cycle.
When billing for CPT code 11760 (Repair of nail bed), the following modifiers may be applicable depending on the specific circumstances of the procedure:
1. Modifier -50 (Bilateral Procedure)
- Use this modifier if the repair of the nail bed is performed on both sides (e.g., both hands or both feet).
2. Modifier -51 (Multiple Procedures)
- Apply this modifier if multiple procedures are performed during the same surgical session. This indicates that the nail bed repair is one of several procedures.
3. Modifier -52 (Reduced Services)
- Use this modifier if the procedure was partially reduced or eliminated at the physician's discretion.
4. Modifier -59 (Distinct Procedural Service)
- This modifier is used to indicate that the nail bed repair is a distinct procedural service from other services performed on the same day.
5. Modifier -76 (Repeat Procedure by Same Physician)
- Apply this modifier if the same physician repeats the nail bed repair procedure on the same day.
6. Modifier -77 (Repeat Procedure by Another Physician)
- Use this modifier if a different physician repeats the nail bed repair procedure on the same day.
7. Modifier -78 (Unplanned Return to the Operating/Procedure Room by the Same Physician Following Initial Procedure for a Related Procedure During the Postoperative Period)
- This modifier is used if the patient returns to the operating room for a related procedure during the postoperative period of the initial nail bed repair.
8. Modifier -79 (Unrelated Procedure or Service by the Same Physician During the Postoperative Period)
- Apply this modifier if an unrelated procedure is performed by the same physician during the postoperative period of the initial nail bed repair.
9. Modifier -80 (Assistant Surgeon)
- Use this modifier if an assistant surgeon is required during the nail bed repair procedure.
10. Modifier -82 (Assistant Surgeon (when qualified resident surgeon not available))
- This modifier is used when an assistant surgeon is necessary, and a qualified resident surgeon is not available.
11. Modifier -AS (Physician Assistant, Nurse Practitioner, or Clinical Nurse Specialist Services for Assistant at Surgery)
- Apply this modifier if a physician assistant, nurse practitioner, or clinical nurse specialist assists in the surgery.
Each modifier provides specific information about the circumstances under which the nail bed repair was performed, ensuring accurate billing and reimbursement.
When considering the reimbursement of CPT code 11760 (Repair of nail bed) by Medicare, it is essential to refer to the Medicare Physician Fee Schedule (MPFS). The MPFS is a comprehensive listing of the maximum fees Medicare will pay for various services, including surgical procedures like the repair of a nail bed.
To determine if CPT code 11760 is reimbursed by Medicare, healthcare providers should consult the MPFS. This schedule is updated annually and provides detailed information on the reimbursement rates for specific CPT codes. Additionally, Medicare Administrative Contractors (MACs) play a crucial role in this process. MACs are responsible for processing Medicare claims and can provide region-specific information regarding the reimbursement of CPT code 11760.
In summary, CPT code 11760 is reimbursed by Medicare, but the exact reimbursement rate can be found by consulting the Medicare Physician Fee Schedule and the relevant Medicare Administrative Contractor for your region.
Discover how MD Clarity's RevFind software can meticulously analyze your contracts and pinpoint underpayments down to the CPT code level, including specific codes like 11760. Schedule a demo today to see how RevFind can help you ensure accurate reimbursements from every payer.
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